1Division of Epidemiology, University of Toronto Dalla Lana School of Public Health, Toronto, Ontario, Canada

2Rouge Valley Health System, Toronto, Ontario, Canada

3Department of Family and Community Medicine, Institute for Clinical Evaluative Sciences, Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto,Toronto, Ontario, Canada

Abstract

Objective To synthesise, quantify and compare risks for incident myocardial infarction (MI) across five major types of arthritis in population-based studies.

Methods A systematic search was performed in MEDLINE, EMBASE and CINAHL databases with additional manual/hand searches for population-based cohort or case-control studies published in English of French between January 1980 and January 2015 with a measure of effect and variance for associations between incident MI and five major types of arthritis: rheumatoid arthritis (RA), psoriatic arthritis (PsA), ankylosing spondylitis (AS), gout or osteoarthritis (OA), adjusted for at least age and sex. All search screening, data abstraction quality appraisals were performed independently by two reviewers. Where appropriate, random-effects meta-analysis was used to pool results from studies with a minimum of 10 events.

Conclusions MI risk was consistently increased in multiple types of arthritis in population-based studies, and was partially explained by a higher prevalence of traditional risk factors in all types of arthritis. Findings support more integrated cardiovascular (CV) prevention strategies for arthritis populations that target both reducing inflammation and enhancing management of traditional CV risk factors.

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Footnotes

Handling editor Tore K Kvien

Contributors OS designed and prepared the study protocol, developed the search strategy in conjunction with an information specialist, performed search screening, data abstraction, quality appraisal of studies, carried out the analysis and interpretation of results and drafted the manuscript. She is guarantor. CT performed search screening, data abstraction, quality appraisal of studies, revised and approved the manuscript. SH-J, RHG and EMB contributed to the study design, protocol, analysis plan, interpretation of the results and revised and approved the manuscript.

Funding OS received a doctoral training award from the Fonds de la Recherche du Québec—Santé. RHG is supported as a Clinician Scientist in the Department of Family and Community Medicine at the University of Toronto and at St. Michael's Hospital.

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